Please share any helpful details or specific amounts you may have an urgent need for (i.e.; a bill; urgent supplies, groceries, gas, etc.)

Your answer

What kind of damage does your home have?

Flood Damage

Fire Damage

Wind Damage

Physical Damage

How would you describe the damage and its extent? (Ex: Flooding of 5ft in my home which required rescue; flooding of 6 inches in my downstairs; both cars and house are flooded, unsure of extent of damage, etc.)

Your answer

Do you own or rent your home?

Own

Rent

Do you have flood insurance?

Yes

No

Do you have renters insurance?

Yes

No

Is your immediate family together?

Yes

No

Do you have transportation now?

Yes

No

Did you have a car flood?

Yes

No

If yes, do you have: (check all that apply)

Full Coverage

Liability Insurance Only

Gap Insurance

Did you lose all your vehicles?

Yes

No

Do you know any other Citymark family in need? Please list their name and contact information.